Strengthening of Home Based Essential New-born and Maternal Health Care by ASHAs in Haryana Using Mobile Phone Technology

Background

Since the inception of NRHM (2005), a lot of progress has been made in the field of maternal, new-born and child health in Haryana. Despite many efforts, there has been slower than expected decline in new-born mortality rate in the state. The training of all levels of health care providers including ASHAs has not lead to a change in key practices and behaviours that determine favourable outcomes. Reporting of vital events continues to be unsatisfactory and the current reporting system does not lend itself to timely action, if there are problems. SWACH had an experience of working in villages of Bilaspur using mobile phone technology in the form of phone calls and messages in SMS which were extensively used to collect information on vital events, capacity development of ASHAs, follow up of new-borns and solving problems of the families and ASHAs. As a result, reporting of births, deaths, still birth and abortion improved. This was shared with Mission Director, NRHM, Haryana and his team in the state and the district and expressed their willingness to implement it in a backward block Chhachhrauli in district Yamunanagar on a pilot basis.

Development and Pilot Test of a mHealth Interactive Education and Social Support Intervention for Improving Postnatal Health

Postnatal health care includes education and clinical care necessary for ensuring maternal and infant health: neonatal care practices (breastfeeding, newborn hygiene, etc.), prevention activities (immunization, recognition of infant danger signs, etc.), and assessment of maternal physical recovery from childbirth, postpartum mental health, and postnatal contraception adoption. Postnatal care improves maternal physical and mental health, and wellbeing. Extending group-based pregnancy care or women’s group models that have proven successful in improving maternal and neonatal outcomes in South Asia and elsewhere to the postnatal period could show health improvements. However, barriers exist to successfully implement postpartum group care, including logistical challenges of traveling to the facility or group meeting with a young baby and limited mobility in South Asia, including postnatal seclusion. Applying an mHealth approach to postnatal care may help new mothers overcome such challenges, and high mobile phone penetration in Haryana state, India, supports the feasibility of testing a group mHealth intervention in this population. Most mHealth interventions for maternal and child health (MCH) in low and middle-income countries, including India, have focused on unidirectional and non-interactive approaches, primarily text messaging. However, ample evidence suggests that provider-led, interactive educational programming and social support are key for improving health behaviors and outcomes. It was proposed to develop a mobile interactive education and support group intervention, Maa Shishu Swasthya Sahayak Samooh (MeSSSSage), to improve the health and well-being of Indian women and infants in the postnatal period using a provider-moderated group approach with aims to reduce postnatal care barriers arising from distance, economic burden, cultural practices, and fatigue, and provide social support in this time to help reduce women’s postpartum isolation.

In developing countries, particularly rural areas, there is a high rate of home deliveries and a lack of skilled care during the initial weeks after childbirth, leading to a significant number of neonatal deaths. The World Health Organization (WHO) recommends the use of Community Health Workers (CHWs) to provide home-based care in these countries. CHWs are local individuals who are selected and trained to improve basic healthcare access and educate the community. In India, under the Home Based Post Natal Care (HBPNC) program, Accredited Social Health Activists (ASHAs) are mandated to make regular home visits to new mothers and promote globally approved newborn care practices. These home visits have been proven effective in improving the health of newborns. However, studies have shown that ASHAs require regular refresher training and innovative strategies to enhance their skills. Technology-enabled health education is seen as a viable solution to train ASHAs and the community, but there are challenges in rural areas such as financial limitations, low literacy rates, poor infrastructure, and weak internet connectivity. To address these constraints, a low-cost training and learning platform called "Sangoshthi" in collaboration with Indraprastha Institute of Information Technology (IIIT) was proposed for CHWs in low-resource settings. Sangoshthi was built on the existing work of Sehat ki Vani, which has been revamped and renamed as Citizen Radio for better stability in low-bandwidth internet contexts. Sangoshthi programme was organised in 2 phases---- Sangoshthi 1.0 and Sangoshthi 2.0.